Combining Healthy Lifestyle Habits with GLP-1 Medications Reduces Cardiovascular Risk in Type 2 Diabetes Patients
A study of over 63,000 veterans with Type 2 diabetes found that combining GLP-1 receptor agonist medications with at least six healthy lifestyle habits reduced cardiovascular event risk by 50% compared to standard care alone.
People with Type 2 diabetes who combined healthy lifestyle habits with GLP-1 receptor agonist medications showed significantly greater reduction in cardiovascular risk compared to those relying on medication alone, according to research to be presented at the American Heart Association's Scientific Sessions 2025. The study of more than 63,000 military veterans found that those adopting at least six healthy lifestyle factors while taking GLP-1 RA medications had a 50% lower risk of major cardiovascular events compared to participants who did not use these medications and followed three or fewer healthy lifestyle habits.
The findings highlight the complementary benefits of medication and lifestyle interventions for cardiovascular protection in diabetes patients. "Lifestyle modifications are recommended as the cornerstone for preventing and managing Type 2 diabetes," said lead study author Xuan-Mai Nguyen, M.D., Ph.D., a researcher with the Department of Veterans Affairs Boston Healthcare System. "Our study's findings suggest that people with Type 2 diabetes taking GLP-1 receptor agonists can improve their heart health even more by adding and maintaining healthy lifestyle habits."
The research analyzed data from the Million Veteran Program, a national initiative studying how genes, lifestyle, military experiences and exposures affect health and wellness in U.S. veterans. Researchers examined eight heart-healthy lifestyle factors: healthy eating, physical activity, not smoking, restful sleep, no-to-moderate alcohol intake, good stress management, social connection and support, and no opioid addiction. The study included 418,513 person-years of follow-up, with participants tracked from 2011 to September 30, 2023.
The analysis revealed several key findings. Participants adhering to all eight healthy lifestyle habits had a 63% lower risk of major cardiovascular events compared to those following one or fewer habits. Those taking GLP-1 RA medications alone showed a 20% lower risk compared to non-users, consistent with previous research. However, the combination of medication with multiple healthy lifestyle factors produced the most substantial benefits. All healthy lifestyle factors examined were independently associated with lower likelihood of major adverse cardiovascular events when analyzed individually.
The significance of these findings is amplified by the growing diabetes epidemic and its cardiovascular implications. According to Know Diabetes by Heart, a collaborative initiative of the American Heart Association and the American Diabetes Association available at https://knowdiabetesbyheart.org, people living with Type 2 diabetes are twice as likely to die from cardiovascular disease. The incidence of Type 2 diabetes has more than doubled in the past 20 years in the U.S., making effective prevention strategies increasingly critical.
Chiadi E. Ndumele, M.D., Ph.D., FAHA, chair of the American Heart Association's Council on Lifestyle and Cardiometabolic Health, noted that "This is a very interesting study with powerful observations about the combined impact of healthy lifestyle and GLP-1 RA use on cardiovascular risk." He emphasized that "Rather than medications versus lifestyle, health care professionals should really be emphasizing both to achieve the best clinical outcomes for our patients."
The study does have limitations, including its observational nature and the predominantly white male veteran population, which may limit generalizability to more diverse groups. Additionally, the research does not predict cardiovascular risk changes for adults without Type 2 diabetes who take GLP-1 RA medications for obesity treatment. Despite these limitations, the findings provide compelling evidence for integrated treatment approaches combining pharmaceutical interventions with comprehensive lifestyle modifications.
As Nguyen summarized, "Taking a GLP-1 RA alone is less effective than combining it with other beneficial lifestyle factors. Achieving some healthy lifestyle behaviors can lower the risk of a major adverse cardiovascular event. The more healthy lifestyle factors adopted, the better." This research underscores the importance of holistic diabetes management that addresses both pharmacological and behavioral aspects of care.